It’s showtime for Washington, DC, collaborative practice agreements

Broad agreement opens possibility for a range of pharmacist-provided services

A more than 5-year journey finally came to an end in August 2018, when Washington, DC, finalized regulations for the city’s collaborative practice agreements (CPAs). CPAs establish formal practice relationships between pharmacists and prescribers by identifying functions that can be delegated to the pharmacist by the collaborating prescriber.

Broad range of services
LCDR Andrew Gentles, PharmD, BCPS AQ-ID, is a commissioned officer for the U.S. Public Health Service who is currently stationed at FDA. He also practices at Community of Hope, Conway Clinic, in Southeast Washington, DC, as a clinical pharmacist and is president of the Washington DC Pharmacy Association (WDCPhA).

“The amazing thing about this CPA is that it was written to be very broad, so it opens up opportunities for pharmacists who practice in many different specialties or have different backgrounds,” Gentles said. While many CPAs throughout the country are focused on chronic disease management or other specific domains, DC’s agreement “was not written to specifically highlight any one area over the other.”

DC stipulates that pharmacists may only establish CPAs with physicians, not other prescribers like nurse practitioners or physician assistants—but formal agreements can be initiated by patients in addition to health care providers looking to team up. Along with addressing community pharmacists, the CPA also sets forth guidelines for pharmacists practicing in hospital settings.

Getting it done
Establishing CPAs was a priority for Gentles and the association. The initial law permitting CPAs was enacted in 2012, but legislative and regulatory hurdles had to be overcome before the CPAs could be put into use.

“It’s like having a law that stipulates how fast you can drive, but unless there are regulations in place, then there are no safeguards to protect the public and the person behind the wheel,” Gentles said.

WDCPhA organized a letter-writing campaign to motivate the Washington, DC, Department of Health to push CPAs over the finish line. Gentles said that student pharmacists from Howard University College of Pharmacy were major drivers in raising awareness. The association was also supported by independent pharmacy owners, health systems such as Kaiser Permanente and George Washington University Hospital, as well as local wraparound clinics including Community of Hope, Whitman-Walker Health, and Andromeda Transcultural Health.

Uniquely DC
Although health care stakeholders consider establishing CPAs for pharmacists’ services to meet the needs of underserved populations, “the District has [the nation’s] highest rate of residents who are insured,” Gentles said. “But despite this high rate of insurance, patients and the [city’s] residents are just not utilizing care. So it’s really exciting for us because patients often go to the pharmacy, even for an over-the-counter cold drop.”

Continuity of care is another big benefit. “If a pharmacist has a collaborative practice agreement with Dr. Lawrence down the street, they can tell the patient, ‘Let me contact him so we can get you into care right away,’ ” Gentles said.

Gentles said the main takeaway is that “we need to always make sure that it goes back to improving access to care, proving that [pharmacists’ services] improve patient outcomes, and displaying the contribution that pharmacists bring to the health care team.” He added that CPAs are a great tool “to demonstrate the skills that we’ve long talked about providing to the patients that we care for.”

Next steps
In the coming months, Gentles said the association will focus on engaging and generating enthusiasm among its members through webinars and town halls and eventually will roll out a strategic framework for setting up CPAs in tandem with the city’s health care stakeholders and its managed care organizations. “But,” he said, “the first part is to celebrate.”